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Glomerulosclerosis Percentage Significance — ESENeph MCQ

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HardChronic Kidney DiseaseGlomerulosclerosis Percentage SignificanceESENeph

A 72-year-old undergoes a kidney biopsy containing 18 glomeruli. Four are globally sclerosed and there is mild IFTA. How should chronic damage be interpreted?

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Correct answer: A — Age-reference comparison plus sample-adequacy and disease-context assessment

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

B is correct. Global sclerosis and IFTA are chronicity markers, but normal reference limits increase with age and depend on biopsy sampling. Modern age-based percentiles are more defensible than the memorable but inaccurate “one percent per year” shortcut. A presents that shortcut as a validated law. C turns limited chronic damage into kidney failure. D discards a useful prognostic feature. E treats age as proof that all scarring is benign. Interpretation integrates the number of glomeruli, vascular changes, clinical phenotype and whether chronicity is disproportionate for age; it may influence prognosis without by itself deciding that active disease cannot benefit from treatment.

Reference: Age-based thresholds for nephrosclerosis on kidney biopsy: https://pmc.ncbi.nlm.nih.gov/articles/PMC10400104/